The Importance of Early Intervention

“Early intervention” is a term that medical and other professionals use to describe the identification and treatment of developmental or physical challenges in children from birth until three years of age.

When it comes to an infant or child who is deaf or hard of hearing, early intervention is extremely important because the human brain is programmed to learn language during the first six years of life – with the first three-and-a-half years being the most critical. Without intervention, it becomes increasingly difficult to acquire language as a child grows older.

The earlier a child's speech and language problems are identified and treated, the less likely it is that problems will persist or worsen. Early speech and language intervention can help children be more successful with reading, writing, schoolwork and interpersonal relationships. In fact, infants and young children whose hearing loss is detected early and who receive appropriate and timely intervention have an excellent chance to develop these important life skills alongside their hearing peers.

As a result of Early Hearing Detection and Intervention (EHDI) legislation enacted in 2000, most hospitals today screen for hearing loss before a newborn is discharged from the hospital. The initial exam is referred to as a “screening” because the testing is not as involved as a comprehensive hearing examination and so, the results are not definitive. Follow-up testing that involves a comprehensive hearing evaluation is required to confirm the diagnosis of a hearing loss.

If an initial screening comes back with a fail result in one or both ears, then a second screening and, perhaps, follow-up testing will be recommended to confirm whether a hearing loss is present and, if so, the type and nature of the loss. This should be done by an audiologist (someone with an advanced degree and appropriate licensure/certification in evaluating hearing) with pediatric experience and the ability to conduct a thorough assessment. It is important that parents do not wait to have the recommended follow-up testing done. Every moment counts when it comes to helping a child who, ultimately, is found to be deaf or hard of hearing. Providing improved access to sound is of utmost importance in helping a child hear and develop a foundation for listening. Putting your child into intervention services should assist you in providing your child with improved access to sound (typically, through appropriately-fitted hearing technology) and access to services and supports that result in development of speech, language and literacy.

Once a hearing loss is confirmed, your pediatrician should refer your child to an ear, nose and throat (ENT) specialist, a physician also known as an otolaryngologist, who will evaluate your child to determine if there is an underlying cause to your child’s hearing loss. In addition to making recommendations related to treatment, an ENT physician who specializes in pediatrics may also provide information on various communication approaches for your child.

What is involved in screening?

Hearing screening methods for infants and children are non-invasive and painless.

ABR (Automated Brain Stem Response): Sounds are presented through earphones while the baby rests quietly or sleeps. Brainstem responses to sound are measured through small electrodes, which are taped on the baby’s head. These responses are processed by a computer.

OAE (Otoacoustic Emissions): A small probe tip is inserted into the baby’s ear canal. It measures the function of the inner ear, or cochlea. This screening can also be performed on a sleeping infant.

Behavioral Testing: These types of tests are used when a child is old enough to turn his or her head in response to sound or play a game. These tests measure the quietest sounds the child can hear and the child’s ability to understand words.

Acoustic Impedance Tests: These tests can be administered to children of all ages and can help identify middle ear problems (e.g., the presence of fluid and the status of eardrum) through quick, non-invasive, computerized technique.

Time is of the essence. Get early intervention services started as quickly as possible to begin working on development of listening and spoken language.

Fortunately, most states offer early intervention up to age three through the local public school, healthcare or family services systems for parents who have children with hearing loss (also known as parent/infant programs). Regardless of which agency is responsible for running the state early intervention program, professionals who work or are contractors for the early intervention system will work with your family. A small group of professionals will evaluate your child and work with your family to develop an Individualized Family Service Plan (IFSP). The IFSP, a legal document, acts as a roadmap for intervention and language development for your child and family. A case manager, or service coordinator, helps families coordinate the services that are discussed and included on this important roadmap and acts as a primary early intervention contact for the family as they address their child’s early intervention needs related to hearing loss, speech and language development, and any other developmental area that may be of concern to the parents. The amount of therapy or intervention services that a state provides varies, so be sure to ask your case manager or service coordinator about the levels of service you can expect. Also, if listening and spoken language is a desired outcome for your child, you should, at the minimum, consult with a certified Listening and Spoken Language Specialist in person or by phone. While there are not currently enough certified Listening and Spoken Language Specialists to provide direct services to all children with hearing loss, many of these highly qualified, experienced professionals are able and willing to provide a consultation to families who seek their assistance.

One critical benefit of early intervention is that it helps families gather as much information as possible as they consider the best language and communication approach for their child. Once your child is diagnosed with a hearing loss, the early intervention process provides you with an opportunity to speak further with trained early intervention professionals such as audiologists, speech-language pathologists, and/or educators of the deaf. Coupled with medical follow-up with your child’s primary care provider, otolaryngologists (ear, nose and throat specialists) and, in many cases, a pediatric geneticist, early intervention and medical/health professionals can help you understand the cause(s) of your child’s condition and work with you as you explore the full range of available and appropriate treatment options and approaches.

Early intervention programs also offer a number of services for you, including parent counseling, explanation of the various communication options for children with hearing loss, training in the communication approach you select and consultation as to how to acquire hearing aids and assistive listening devices that will allow your child good access to sound and speech.

You do. As the parent, you are entitled and it is your job to select the communication approach(es) you want to use with your child to help him or her develop language. Early intervention is designed to allow you and your family, as the most important people in your child’s life, to serve as your child’s primary models and teachers of language and to become educated and comfortable. That’s why the process emphasizes the family unit, not only the child with hearing loss. Early intervention should put services in place that allow you to fulfill your role and that of other family members to be capable and confident as your child’s primary language models. Early intervention services often serves as a jump start to your child’s communication skills and progress over time. If, as your child’s parent, you find your child is not making progress or you have any concerns at all, talk with your family’s early intervention service coordinator.

If you feel uncertain, or even lost about what needs to happen for your child, contact AG Bell at [email protected]

Working globally to ensure that people who are deaf and hard of hearing can hear and talk.

We want all families to be informed and supported, professionals to be appropriately qualified to teach and help children with hearing loss, public policy leaders to effectively address the needs of people with hearing loss, and communities to be empowered to help their neighbors with hearing loss succeed.